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HIV and acute cough
Apr 16, 2008

She has HIV with CD4 count less than 120,but with acute persistant cough.She tested negative for TB but the cough can just stop.I have given her some cough syrup but it still persist. Do i treat for latent TB?

Response from Dr. Young

I think that this is a tad too complex a case to answer with detail.

First off, if the patient was SKIN tested for TB, this is a very highly insensitive test. A negative skin test in a patient with a CD4 of 120 would have a very low predictive value. If available, I'd perform a Quantiferon test for TB- one that is becoming more widely available and much more predictive in persons with low CD4s.

I'd be looking at the characteristics of the sputum stains and cultures, chest radiographs for clues to the cause. It may be reasonable to consider bronchoscopy too.

Since there are so many different things in addition to TB that can cause cough in persons with AIDS (PCP, bacterial pneumonia, viral pneumonia, tumor), I would defer on the issue of treatment of latent TB until more data arises.

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